Department of Anesthesiology, Xiangya Hospital, Central-South University, Changsha, Hunan, China.
Reg Anesth Pain Med. 2011 Jan-Feb;36(1):56-62. doi: 10.1097/AAP.0b013e318203087f.
Inflammatory responses in the lumbar dorsal root ganglion (DRG) play a key role in pathologic pain states. Systemic administration of a common anti-inflammatory corticosteroid, triamcinolone acetonide (TA), reduces sympathetic sprouting, mechanical pain behavior, spontaneous bursting activity, and cytokine and nerve growth factor production in the DRG. We hypothesized that systemic TA effects are primarily due to local effects on the DRG.
Male Sprague-Dawley rats were divided into 4 groups: SNL (tight ligation and transection of spinal nerves) and normal with and without a single dose of TA injectable suspension slowly injected onto the surface of DRG and surrounding region at the time of SNL or sham surgery. Mechanical threshold was tested on postoperative days 1, 3, 5, and 7. Immunohistochemical staining examined tyrosine hydroxylase and glial fibrillary acidic protein in DRG and CD11B antibody (OX-42) in spinal cord.
Local TA treatment attenuated mechanical sensitivity, reduced sympathetic sprouting in the DRG, and decreased satellite glia activation in the DRG and microglia activation in the spinal cord after SNL.
A single injection of corticosteroid in the vicinity of the axotomized DRG can mimic many effects of systemic TA, mitigating behavioral and cellular abnormalities induced by spinal nerve ligation. This provides a further rationale for the use of localized steroid injections clinically and provides further support for the idea that localized inflammation at the level of the DRG is an important component of the spinal nerve ligation model, commonly classified as neuropathic pain model.
腰椎背根神经节(DRG)中的炎症反应在病理性疼痛状态中起着关键作用。全身给予常用抗炎皮质类固醇曲安奈德(TA)可减少 DRG 中的交感神经发芽、机械性疼痛行为、自发性爆发活动以及细胞因子和神经生长因子的产生。我们假设全身 TA 的作用主要归因于对 DRG 的局部作用。
雄性 Sprague-Dawley 大鼠分为 4 组:SNL(脊髓神经结扎和切断)和正常组,在 SNL 或假手术时,将 TA 可注射混悬液单次缓慢注射到 DRG 表面及其周围区域。术后第 1、3、5 和 7 天测试机械阈值。免疫组织化学染色检测 DRG 中的酪氨酸羟化酶和胶质纤维酸性蛋白以及脊髓中的 CD11B 抗体(OX-42)。
局部 TA 治疗减轻了机械敏感性,减少了 SNL 后 DRG 中的交感神经发芽,并减少了 DRG 中的卫星胶质细胞激活和脊髓中的小胶质细胞激活。
在轴突切断的 DRG 附近单次注射皮质类固醇可以模拟全身 TA 的许多作用,减轻脊髓神经结扎引起的行为和细胞异常。这为临床上使用局部类固醇注射提供了进一步的依据,并进一步支持了这样一种观点,即 DRG 水平的局部炎症是脊髓神经结扎模型(通常归类为神经性疼痛模型)的一个重要组成部分。